title: Immediate placement of implants into infected sites: a systematic review.
abstract: BACKGROUND
  Traditionally, before placing dental implants, the compromised teeth are removed and the extraction sockets are left to heal for several months. To preserve the alveolar bone level from the collapse caused by healing and to reduce treatment time in situations in which tooth extraction precedes implant placement, some clinicians began to install the implant immediately into the postextraction socket without waiting for the site to heal.
  
  
  OBJECTIVE
  The purpose of this study was to review the literature regarding treatment outcomes of immediate implant placement into sites exhibiting pathology after clinical procedures to perform the decontamination of the implant's site. The following questions were raised: Does the presence of periodontal or endodontic infection affect immediate implant placement success? What is suggested to address the infection in the socket prior to immediate placement?
  
  
  METHODS
  An electronic search in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) was undertaken in March 2013. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included both animal and human studies, and excluded any review and case reports articles. The publication's intervention had to have been implant placement into a site classified as having an infection (periapical, endodontic, perioendodontic, and periodontal).
  
  
  RESULTS
  The search strategy initially yielded 706 references. Thirty-two studies were identified within the selection criteria, from which nine were case reports and review articles and were excluded. Additional hand-searching of the reference lists of selected studies yielded five additional papers.
  
  
  CONCLUSIONS
  The high survival rate obtained in several studies supports the hypothesis that implants may be successfully osseointegrated when placed immediately after extraction of teeth presenting endodontic and periodontal lesions, provided that appropriate clinical procedures are performed before the implant surgical procedure such as meticulous cleaning, socket curettage/debridement, and chlorhexidine 0.12% rinse. However, more randomized controlled clinical trials with a longer follow-up are required to confirm this procedure as a safe treatment. Moreover, the outcome measures were not related to the type of infection; the classification of infection was often vague and varied among the studies. The benefits of antibiotic solution irrigation and systemic antibiotic administration in such conditions are not yet proved and remain unclear.
authors.affiliation: Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Bruno Ramos
authors.initials: BR
authors.lastname: Chrcanovic
authors.forename: Maximiliano Delany
authors.initials: MD
authors.lastname: Martins
authors.forename: Ann
authors.initials: A
authors.lastname: Wennerberg
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000382:microbiology*; D003646:Debridement; D019232:Dental Restoration Failure; D006801:Humans; D057893:Immediate Dental Implant Loading; D009059:Mouth Diseases / Q000150:complications* / Q000382:microbiology*; D016348:Osseointegration; D010518:Periodontitis; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: dental implants; immediate implant placement; infected extraction sites; infection; tooth socket